Age Impacts Ability of Aspartate–Alanine Aminotransferase Ratio to Predict Advanced Fibrosis in Nonalcoholic Fatty Liver Disease

Goh, George Boon-Bee; Pagadala, Mangesh; Dasarathy, Jaividhya; Pai, Rish K.; Yerian, Lisa; Khiyami, Amer; Sourianarayanane, Achuthan; Sargent, Ruth; Hawkins, Carol; Dasarathy, Srinivasan; McCullough, Arthur J.

doi:10.1007/s10620-015-3529-8

Cited by 24 publications

(18 citation statements)

References 42 publications

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“…However, we also demonstrated that the specificity of the AST/ALT ratio for advanced fibrosis fell with increasing age. This was due to a significant age-related fall in serum ALT levels, which persisted, independent of fibrosis stage and gender, and confirms results of previous studies (33, 34, 35). As both the NFS and FIB-4 score include a ratio of the AST and ALT in their models, this may well also contribute to the overall reduction in specificity with increasing age.…”

Section: Discussionsupporting

confidence: 90%

Age as a Confounding Factor for the Accurate Non-Invasive Diagnosis of Advanced NAFLD Fibrosis

McPherson

Hardy

Dufour

et al. 2017

American Journal of Gastroenterology

606

567

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OBJECTIVES:Non-invasive fibrosis scores are widely used to identify/exclude advanced fibrosis in patients with non-alcoholic fatty liver disease (NAFLD). However, these scores were principally developed and validated in patients aged between 35 and 65 years of age. The objective of this study was to assess the effect of age on the performance of non-invasive fibrosis tests in NAFLD.METHODS:Patients were recruited from European specialist hepatology clinics. The cohort was divided into five age-based groups: ≤35 (n=74), 36–45 (n=96), 46–55 (n=197), 56–64 (n=191), and ≥65 years (n=76), and the performance of the aspartate aminotransferase (AST)/alanine transaminase (ALT) ratio, fibrosis 4 (FIB-4), and NAFLD fibrosis score (NFS) for advanced fibrosis (stage F3–F4) for each group was assessed using liver biopsy as the standard.RESULTS:Six hundred and thirty-four patients were included. The diagnostic accuracy of the AST/ALT ratio was lower than NFS and FIB-4 in all the age groups. The AST/ALT ratio, NFS, and FIB-4 score performed poorly for a diagnosis of advanced fibrosis in those aged ≤35 years (area under the receiver operating characteristic curves (AUROCs 0.52, 0.52, and 0.60, respectively). For all groups >35 years, AUROCs for advanced fibrosis were similar for the NFS and FIB-4 score (range 0.77–0.84). However, the specificity for advanced fibrosis using the FIB-4 and NFS declined with age, becoming unacceptably low in those aged ≥65 years (35% for FIB-4 and 20% for NFS). New cutoffs were derived (and validated) for those aged ≥65 years, which improved specificity to 70% without adversely affecting sensitivity (FIB-4 2.0, sensitivity 77% NFS 0.12, sensitivity 80%).CONCLUSIONS:The NFS and FIB-4 scores have similar accuracy for advanced fibrosis in patients aged >35 years. However, the specificity for advanced fibrosis is unacceptably low in patients aged ≥65 years, resulting in a high false positive rate. New thresholds for use in patients aged ≥65 years are proposed to address this issue.

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Section: Discussionsupporting

confidence: 90%

Age as a Confounding Factor for the Accurate Non-Invasive Diagnosis of Advanced NAFLD Fibrosis

McPherson

Hardy

Dufour

et al. 2017

American Journal of Gastroenterology

606

567

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“…Employing widely used cut-offs for elevated ALT and AST, we found a 70.2% prevalence of elevated LFTs in the younger group, which was similar to the prevalence for the middle-aged group and significantly higher than that for the older group. Research indicates that ALT levels may decrease slightly with age (29), but our findings were nonetheless remarkable. Given the documented high rates of nonalcoholic fatty liver disease in this cohort (30), the authors believe that this association is real and that the drivers of elevated liver enzymes in young Mexican American men warrant further study.…”

Section: Discussioncontrasting

confidence: 47%

The Precarious Health of Young Mexican American Men in South Texas, Cameron County Hispanic Cohort, 2004–2015

et al. 2016

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IntroductionHispanic men have higher rates of illness and death from various chronic conditions than do non-Hispanic men. We aimed to characterize the health of Mexican American men living on the US–Mexico border in South Texas and elucidate indications of chronic disease in young men.MethodsWe sampled all male participants from the Cameron County Hispanic Cohort, an ongoing population-based cohort of Mexican Americans in Brownsville, Texas. We calculated descriptive statistics and stratified the sample into 3 age groups to estimate the prevalence of sociodemographic, behavioral, and clinical factors by age group and evaluated differences between age groups.ResultsObesity prevalence was approximately 50% across all age groups (P = .83). Diabetes prevalence was high overall (26.8%), and 16.9% (95% confidence interval [CI], 10.1%–23.8%) of men younger than 35 had diabetes. More than 70% of these young men had elevated liver enzymes, and mean values of aspartate aminotransferase were significantly higher in younger men (45.0 u/L; 95% CI, 39.5–50.6 u/L) than in both older age groups. Less than 20% of young men had any form of health insurance. Current smoking was higher in young men than in men in the other groups, and the rate was higher than the national prevalence of current smoking among Hispanic men.ConclusionsWe suggest a need for obesity and diabetes prevention programs and smoking cessation programs for men in this region. Opportunities exist to expand current intervention programs and tailor them to better reach this vulnerable population of young Hispanic men. Elevated liver enzymes in men younger than 35 suggest a substantial burden of liver abnormalities, a finding that warrants further study.

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“…Numerous researches shown that ALT and AST are key enzymes measured in serum or plasma to investigate liver diseases (Carobene et al 2013), and the ratio of AST to ALT can be used to identify non-alcoholic fatty liver disease (Goh et al 2015). The activities of ALT and AST in the serum can also observed for the indication of hepatic dysfunction (Chen et al 2015; Liang et al 2015).…”

Section: Discussionmentioning

confidence: 99%

Preventing subclinical necrotic enteritis through Lactobacillus johnsonii BS15 by ameliorating lipid metabolism and intestinal microflora in broiler chickens

et al. 2017

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Increasing studies have focused on the beneficial effects of Lactobacillus johnsonii in certain diseases. Here, we studied the prevention ability of a probiotic strain, L. johnsonii BS15 on subclinical necrotic enteritis (SNE), and its underlying mechanism. 180 male Cobb 500 chicks were randomly allotted into three groups and administrated with BS15 (1 × 106 cfu/g) or Man Rogosa Sharpe liquid medium throughout a 28-day experimental period. With the exception of the normal group, SNE infection was treated for the remaining experimental period after the chicks were fed with normal diet 14 days. Results showed that BS15 notably suppressed the SNE-induced loss of average daily gain and liver functional abnormality. Additionally, BS15 facilitated lipid metabolism of SNE boilers when the contents of peroxisome proliferator activated receptor γ and adipose triglyceride lipase in adipose tissue and serum high-density lipoprotein cholesterol decreased. BS15 also attenuated the hepatic lipid accumulation of stricken chicks by suppressing the genes expression of acetyl-CoA carboxylase, fatty acid synthase and sterol regulatory element binding protein-1c as well as stimulating the genes expression of peroxisome proliferator activated receptor α and carnitine palmitoyltransferase-1. Moreover, BS15 enhanced the development of SNE gut by improving the intestinal development and digestion as well as adjusting the gut microflora. Therefore, BS15 may provide a promising natural preventative strategy against SNE, which may be contributed to the amelioration of lipid metabolism and intestinal microflora.

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Age Impacts Ability of Aspartate–Alanine Aminotransferase Ratio to Predict Advanced Fibrosis in Nonalcoholic Fatty Liver Disease

Cited by 24 publications

References 42 publications

Age as a Confounding Factor for the Accurate Non-Invasive Diagnosis of Advanced NAFLD Fibrosis

Age as a Confounding Factor for the Accurate Non-Invasive Diagnosis of Advanced NAFLD Fibrosis

The Precarious Health of Young Mexican American Men in South Texas, Cameron County Hispanic Cohort, 2004–2015

Preventing subclinical necrotic enteritis through Lactobacillus johnsonii BS15 by ameliorating lipid metabolism and intestinal microflora in broiler chickens

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